Citation Nr: 0823181
Decision Date: 07/14/08 Archive Date: 07/23/08
DOCKET NO. 06-37 252 ) DATE
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On appeal from the
Department of Veterans Affairs Regional Office in
Philadelphia, Pennsylvania
THE ISSUE
Entitlement to service connection for atrial fibrillation,
claimed as secondary to service-connected diabetes mellitus.
REPRESENTATION
Appellant represented by: Pennsylvania Department of
Military and Veterans Affairs
WITNESS AT HEARING ON APPEAL
Appellant, Appellant's wife
ATTORNEY FOR THE BOARD
Jebby Arnold, Law Clerk
INTRODUCTION
The veteran served on active duty from May 1968 to April
1970.
This case comes before the Board of Veteran's Appeals (Board)
on appeal of August 2005 and November 2005 rating decisions
issued by the Department of Veteran's Affairs (VA) Regional
Office (RO) in Philadelphia, Pennsylvania. Those rating
decisions, in pertinent part, denied the veteran's claim for
entitlement to service connection for atrial fibrillation.
The appeal is REMANDED to the RO via the Appeals Management
Center (AMC), in Washington, DC. VA will notify the
appellant if further action is required.
REMAND
VA is obliged to provide an examination when: the record
contains competent evidence that the claimant has a current
disability or signs and symptoms of a current disability; the
record indicates that the disability or signs and symptoms of
disability may be associated with active service; and the
record does not contain sufficient information to make a
decision on the claim. 38 U.S.C.A. § 5103A(d) (West 2002).
The evidence of a link between the current disability and
service must be competent. Wells v. Principi, 326 F.3d 1381
(Fed. Cir. 2003).
Service connection is warranted for a disability which is
proximately due to, or the result of, a service-connected
disability or where a service-connected disability aggravates
a non-service-connected disability. 38 C.F.R. § 3.310(a);
Allen v. Brown, 7 Vet.App. 439 (1995).
The threshold for triggering VA's duty to provide an
examination is low. McLendon v. Nicholson, 20 Vet. App. 79,
83 (2006).
An October 2004 rating decision granted the veteran
entitlement to service connection for diabetes mellitus type
II with a 20 percent evaluation effective August 10, 2004.
The Board notes that the veteran underwent a VA examination
in June 2005 to evaluate his complaints of atrial
fibrillation and determine if there was a link between that
condition and his diabetes mellitus. The VA examiner found
no evidence of atrial fibrillation and thus no link between
that condition and the veteran's diabetes.
However, physicians at Abington Memorial Hospital
subsequently diagnosed the veteran with, and treated him for,
atrial fibrillation in August 2005.
The veteran is entitled to a new VA examination where there
is evidence that the condition has worsened since the last
examination. Snuffer v. Gober,10 Vet.App. 400 (1997);
Caffrey v. Brown, 6 Vet.App.377 (1994); VAOPGCPREC 11-95
(1995). Medical records and the veteran's testimony suggest
that the disability has worsened while the veteran's report
of current symptoms provides competent evidence of a current
condition of atrial fibrillation. Because the veteran's
condition has worsened in the course of his appeal, the Board
finds that a new VA examination is needed for additional
development.
Following an October 2006 statement of the case that
continued the denial of his claim for entitlement for service
connection for atrial fibrillation as directly secondary to
service-connected diabetes, in December 2006 the veteran
alternatively argued that his atrial fibrillation was
indirectly (via his hypertension, for which he was denied
service connection in March 1982 and April 2003) caused by
his diabetes.
Lay persons are not competent to opine as to medical etiology
or render medical opinions. Barr v. Nicholson; see Grover v.
West, 12 Vet.App. 109, 112 (1999); Espiritu v. Derwinski, 2
Vet.App. 492, 494 (1992). However, a December 2006 VA
examination was conducted to determine if the veteran's
atrial fibrillation was caused by his hypertension. This
examiner did not address the possibility of a direct
relationship between the veteran's diabetes and atrial
fibrillation.
In this case, the Board notes that competent medical evidence
of record does not adequately address whether the veteran's
atrial fibrillation was caused or aggravated by his service-
connected diabetes mellitus. As such, there is inadequate
basis for the Board to determine whether the veteran's atrial
fibrillation is related to his service-connected diabetes.
Stefl v. Nicholson, 21 Vet.App. 120 (2007) (noting that a
medical opinion must describe the disability in sufficient
detail so the Board can make a fully informed evaluation of
the disability). An examination, focusing on the
relationship, if any, between the veteran's current
conditions of diabetes and atrial fibrillation, is in order
prior to further appellate consideration of the appellant's
claim.
Accordingly, the case is REMANDED for the following actions:
1. The veteran should be afforded an
examination, by a cardiologist, for a
medical opinion regarding the etiology of
the veteran's atrial fibrillation. The
examiner must review the veteran's claims
file in conjunction with the examination.
After the completion of the examination
and review of the record, the examiner
should opine: 1) whether it is at least as
likely as not (a 50% or better
probability) that the veteran's heart
disease was (a) caused (proximately due
to) or (b) aggravated by (and if so, to
what degree) his service-connected
diabetes mellitus or any other service
connected disability. The examiner should
explain the rationale for all opinions
given.
2. If the claim remains denied, a
supplemental statement of the case should
be issued. The case should then be
returned to the Board if otherwise in
order.
The appellant has the right to submit additional evidence and
argument on the matter or matters the Board has remanded.
Kutscherousky v. West, 12 Vet. App. 369 (1999).
This claim must be afforded expeditious treatment. The law
requires that all claims that are remanded by the Board of
Veterans' Appeals or by the United States Court of Appeals
for Veterans Claims for additional development or other
appropriate action must be handled in an expeditious manner.
See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2008).
_________________________________________________
Cheryl Mason
Veterans Law Judge, Board of Veterans' Appeals